UM dissertation award for Dr. Estelle Nijssen

Additional precautions with contrast liquid are unnecesary for many patients with kidney failure

Research by UM scientists at MUMC+ shows that administering extra fluids when treating kidney treatment of kidney patients with iodinated contrast media is often not necessary. The additional fluid causes more healthcare costs, unnecessary hospital admissions and more complications such as heart problems. International guidelines were adapted because of the new research, for which dr. Estelle Nijssen has won the UM dissertation prize.

Iodinated contrast media is used to make organs and vessels more visible in medical examinations and treatments such as a CT scan or doppler. The kidneys filter the fluid from the blood after treatment and so it is subsequently eliminated through the urine. Kidney patients are potentially at risk of kidney damage during this process. In order to prevent this, until recently they In order to prevent this, until recently they were always given extra fluids via an infusion before and after treatment with contrast medium. Patients were admitted to the hospital for 1 or 2 days. 

Administering additional fluids via an infusion was one of the recommendations in the clinical guidelines for safe use of contrast agents. In the Netherlands, this advice was enforced quite strictly: giving the infusion to high-risk patients became one of the quality and safety criteria during hospital audits. However, a pilot showed how burdensome this was for the patient, the hospital and healthcare costs, while less kidney damage was seen than expected. In addition, it turned out that there no sound scientific basis for the advice: researchers found no literature that proved its usefulness.

The lack of a scientific basis prompted further research. Over a period of two years, all high-risk patients who had been referred for an examination or treatment with contrast were divided into two groups. One group received extra fluids via an infusion, the other group did not receive this. Surprisingly, the infusion did not appear to have a demonstrable protective effect: while the group with extra fluid sometimes had complications from the drip, both groups fared equally well in terms of kidney function. 

As a result of the study, national and international guidelines on the safe use of contrast agents were updated. Extra fluids are now only used for 0.5% of patients with severely impaired kidney functions. In the Maastricht UMC+ this led to 100 fewer complications, 1,544 fewer hospital admissions and savings of 1.2 million euros. For the Netherlands and worldwide, these effects will be even greater. 

For the kidney patients themselves, the effects of the study are immediate: they no longer have to hospitalization when they undergo a CT scan or other examination with contrast
with contrast medium.

The study was led by dr. Estelle Claire Nijssen. She was awarded for her research on May 12, 2022, during Maastricht University's Dies Natalis, UM's dissertation award. In the video above Nijssen talks about the results and the impact of the research on clinical practice. 

An article was published in De Limburger (in Dutch). 

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